How foreign aid cuts are setting the stage for disease outbreaks

Boston Globe

09-03-2025

'It's actually in the interest of American people to keep diseases down,' said Dr. Githinji Gitahi, who heads Amref Health Africa, a large nonprofit that relies on the United States for about 25 percent of its funding.
Advertisement
'Diseases make their way to the United States even when we have our best people on it, and now we are not putting our best people on it,' he added.
In interviews, more than 30 current and former officials of the US Agency for International Development, members of health organizations and experts in infectious diseases described a world made more perilous than it was just a few weeks ago.
Many spoke on condition of anonymity for fear of retaliation by the federal government.
The timing is dire: Congo is experiencing the deadliest mpox outbreak in history, with cases exploding in a dozen other African countries.
The United States is home to a worsening bird flu crisis. Multiple hemorrhagic fever viruses are smoldering: Ebola in Uganda, Marburg in Tanzania, and Lassa in Nigeria and Sierra Leone.
In 2023, USAID invested about $900 million to fund labs and emergency-response preparedness in more than 30 countries. The pause on foreign aid froze those programs. Even payments to grantees for work already completed are being sorted out in the courts.
Waivers issued by the State Department were intended to allow some work to continue on containing Ebola, Marburg, and mpox, as well as preparedness for bird flu.
But Trump administration appointees choked payment systems and created obstacles to implementing the waivers, according to a USAID memo by Nicholas Enrich, who was the agency's acting assistant administrator for global health until Sunday.
Advertisement
Then last month, the Trump administration canceled about 5,800 contracts, effectively shuttering most USAID-funded initiatives, including many that had received permission to continue.
'It was finally clear that we were not going to be implementing' even programs that had waivers, Enrich recalled in an interview.
The decision is likely to result in more than 28,000 new cases of infectious diseases such as Ebola and Marburg, and 200,000 cases of paralytic polio each year, according to one estimate.
Secretary of State Marco Rubio 'has been working diligently since being sworn in to review every dollar spent,' the State Department said in an emailed statement.
'We'll be able to say that every program that we are out there operating serves the national interest, because it makes us safer or stronger or more prosperous,'' the statement quoted Rubio as saying.
Most USAID staff members were terminated or placed on administrative leave without warning. The agency had more than 50 people dedicated to outbreak responses, the result of a congressional push to beef up pandemic preparedness.
Now it has six. Those who were fired included the organization's leading expert in lab diagnostics and the manager of the Ebola response. 'I have no idea how six people are going to run four outbreak responses,' said an official who was let go.
Also sent home were hundreds of thousands of community health workers in Africa who were sentinels for diseases.
In early January, the Tanzanian government denied there were new cases of Marburg, a hemorrhagic fever. It was a community health worker trained through a US-funded Ebola program who reported the disease a week later.
Advertisement
The outbreak eventually grew to include 10 cases; it is now under control, the government has said.
Even in quieter times, foreign aid helps to prevent, detect and treat diseases that can endanger Americans, including drug-resistant HIV, tuberculosis and malaria, and bacteria that don't respond to available antibiotics.
Much of that work has stopped, and other organizations or countries cannot fill the gap. Compounding the loss is America's withdrawal from the World Health Organization, which has instituted cost-cutting measures of its own.
'This is a lose-lose scenario,' said Dr. Keiji Fukuda, who has led pandemic prevention efforts at the WHO and the Centers for Disease Control and Prevention.
The slashing of foreign aid deprives the world of American leadership and expertise, but it also locks the United States out of global discussions, Fukuda said: 'For the life of me, I cannot see the justification or the reason for this very calculated, systematic approach to pull down public health.'
Some African countries such as Somalia have fragile health systems and persistent security threats, yet minimal capacity for tracking infections that sicken animals and people, said Abdinasir Yusuf Osman, a veterinary epidemiologist and chair of a working group in Somalia's health ministry.
Each year, Somalia exports millions of camels, cattle, and other livestock, primarily to the Middle East. The nation has relied heavily on foreign aid to screen the animals for diseases, he said.
'The consequences of this funding shortfall, in my view, will be catastrophic and increase the likelihood of uncontrolled outbreaks,' Osman said.
Advertisement
In countries with larger economies, foreign aid has helped build relationships. Thailand is a pioneer in infectious diseases, and USAID was funding a modest project on malaria elimination that boosts its surveillance capabilities.
The abrupt end to that commitment risks losing goodwill, said Jui Shah, who helped run the program.
'In Asia, relationships are crucial for any type of work, but especially for roles that work with surveillance and patient data,' she said. 'Americans will suffer if other countries hesitate to engage with us about outbreaks.'
This article originally appeared in